糖尿病周围神经病变发病机制的研究进展

糖尿病是一种由于机体胰岛素不足和/或功能障碍所致的细胞代谢紊乱疾病,临床表现为血糖升高[1].在糖尿病患者中神经病变约占70%,病变涉及感觉、运动和自主神经,其中50%为末梢神经病变.     

糖尿病周围神经病变疼痛机制研究进展

痛性糖尿病周围神经病变（DPN）表现为对多数镇痛药物的抵抗。最近许多研究表明，背根神经节（DRG）钠离子通道、丝裂原激活蛋白激酶、一氧化氮、蛋白激酶C、去甲肾上腺素等在DPN疼痛信号转导和痛觉调制方面发挥重要作用。现就DPN疼痛的分子机制及治疗前景作一探讨。     

疏血通治疗糖尿病周围神经病变的疗效观察

目的 观察疏血通对糖尿病周围神经病变的治疗效果．探讨护理方法。方法 对70例糖尿病周围神经病变患者均给予疏血通6ml加入0．9%氯化钠注射液250ml静脉输注．1次d．10d为1个疗程。治疗期间严密观察患者的症状、体征及不良反应，及时对症处理。结果 治疗2个疗程总有效率为94．3％。结论 用药过程中．严密药物观察及护理是保证疏血通治疗顺利完成的关键。     

弥可保治疗糖尿病周围神经病变临床分析

为进一步了解弥可保对糖尿病神经病变的疗效，我院对糖尿病合并神经病变的患者进行疗效观察，结果报道如下。     

糖尿病性周围神经病变42例临床特点及治疗体会

目的:对糖尿病性神经病(DPN)的临床表现进行分析和总结.方法:比较符合WHO诊断标准的8例Ⅰ型糖尿病、41例Ⅱ型糖尿病患者周围神经病的临床表现、与病程的关系、血糖的高低、电生理检测的异常.结果:41例糖尿病性周围神经病变患者的临床表现以只肢体疼痛、麻木为主,发病率与病程的延长呈正比关系,神经电生理检测运动传导速度(MCV)和感觉传导速度(SCV)减慢,SCV比MCV异常丰更高.经治疗后病情痊愈17例(40.5%),好转25例(59.5%)结论DPN的发病机理较复杂,临床表现多样化,神经电生理检测中SCV比MCV更敏感,治疗应是包括隆糖、降脂为主的多途径治疗.     

疏血通治疗糖尿病周围神经病变的疗效观察

目的 观察疏血通对糖尿病周围神经病变的治疗效果,探讨护理方法.方法 对70例糖尿病周围神经病变患者均给予疏血通6 ml加入0.9%氯化钠注射液250 ml静脉输注,1次/d,10 d为1个疗程.治疗期间严密观察患者的症状、体征及不良反应,及时对症处理.结果 治疗2个疗程总有效率为94.3%.结论 用药过程中,严密药物观察及护理是保证疏血通治疗顺利完成的关键.     

弥可保辅助治疗68例糖尿病性周围神经病变疗效观察

目的为了解弥可保辅助治疗68例糖尿病并发周围神经病变疗效.方法将68例住院患者随机分为观察组(35例)及对照组(33例),两组均常规行降糖药物治疗,观察组加用弥可保注射液500μg,隔日肌内注射1次,20d为1个疗程.结果治疗组总有效率(88.5%),明显高于对照组(69.7%),两组比较,差异有显著性意义(P＜0.01).结论弥可保辅助治疗糖尿病性周围神经病变疗效显著.弥可保；周围神经病变．糖尿病性     

周围神经显微减压术治疗痛性糖尿病周围神经病变

目的探讨周围神经显微减压术治疗痛性糖尿病周围神经病变(painful diabetic peripheral neuropathy,PDPN)的临床应用及疗效。方法对2017年9月至2018年6月武汉市中心医院神经外科收治的33例PDPN患者,按DELLON术式行周围神经显微减压手术治疗。所有患者术中行神经电生理监测,术后随访0.5~1年。术前及术后0.5年均行肌电图检查及VAS疼痛评分,并对结果进行对照分析。结果PDPN患者行周围神经显微减压术后0.5年,肌电图检查所松解神经,显示所检测神经感觉传导速度(SNCV)较术前明显增快(P<0.05)。术后VAS评分(4.6±1.8)分,较术前(8.3±2.6)明显减低(P<0.05)。结论周围神经显微减压术对PDPN有良好治疗效果,术中电生理监测可有效避免医源性神经损伤。神经电生理检查,可作为明确诊断及评价手术疗效的客观依据。     

Decompression of peripheral nerves for diabetic neuropathy in the lower extremity

Consideration of the presence of a compressive neuropathy overlying an existing diabetic neuropathy in symptomatic patients and surgical decompression of these compressed nerves in selected patients is presented. The short-term results of 33 lower extremities treated with external neurolysis of the common peroneal, deep peroneal, and tarsal tunnel nerves are presented with a mean follow-up time of 3 months (range, 1 to 6 months). The surgery was performed in an attempt to relieve pain and to restore normal sensation in the foot. All procedures were performed under spinal or general anesthesia. Candidates for the procedure were type 1 or type 2 diabetics with symptomatic somatosensory neuropathy (pain, burning, tingling, and/or numbness) and preoperative computer-assisted neurosensory testing that confirmed the presence of elevated nerve threshold levels and axonal degeneration in the foot and leg. External neurolysis of the involved nerves provided good to excellent results in 90.0% of those patients with preoperative neuropathic pain, and restored sensation at good to excellent levels in 66.7% of those patients with preoperative neuropathic numbness. The mean visual analog score for pain assessment was 9.0 preoperatively and 3.2 postoperatively for those patients with pain as a symptomatic complaint (n = 30). There were 4 complications (12%) and all were early cases consisting of a noninfected wound dehiscence of the tarsal tunnel incision, which went on to heal without consequence. These initial short-term results suggest that external neurolysis of the common peroneal, deep peroneal, and tarsal tunnel nerves in selected patients with symptomatic diabetic neuropathy and an overlying compression neuropathy as determined by using computer-assisted neurosensory testing appears to be an effective treatment for providing pain relief and restoration of sensation in the foot.     

超声疗法对改善糖尿病周围神经病变的临床分析

目的观察超声疗法对糖尿病周围神经病变的疗效。方法 60例糖尿病周围神经病变患者,随机分为对照组和治疗组各30例。对照组给予常规治疗,治疗组在常规治疗的基础上加用超声治疗。入院时、治疗15d后分别临床评分并测定肌电图。结果治疗组临床评分明显改善,较对照组明显好转。两组患者比较,差异有统计学意义（P〈0.05）。结论超声疗法有利于糖尿病周围神经病变患者症状的改善和神经功能的恢复,能够提高患者生活质量。     

单纤维肌电图在糖尿病周围神经病变中的变化和意义探讨

目的观察单纤维肌电图（SFEMG）在糖尿病周围神经病变（DPN）中的变化，探讨DPN的发病机制。方法36例已作常规神经传导检测（NCS）的2型糖尿病患者，测定指总伸肌的颤抖和纤维密度（FD），并测量空腹血糖（FBG）、糖化血红蛋白（HbA1c）、总甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆圊醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、脂蛋白a[Lp（a）]、载脂蛋白A（Apo—A）、载脂蛋白B（Apo—B）及血压。结果在18例NCS异常者中，颤抖值均超出正常范围（11例伴阻滞），14例FD增加；18例NCS正常者中，有7例颤抖值增大（3例伴阻滞），5例FD增加。颤抖和FD呈正相关（r=0．7621，P〈0．01），颤抖和FD均与糖化血红蛋白、TG、LDL—C、Lp（a）及舒张压呈正相关。结论SFEMG是DPN早期诊断的敏感手段，可发现亚临床神经病变。血糖、血压、血脂控制不良在DPN的发生和发展中起重要作用。     

Common and contrast determinants of peripheral artery disease and diabetic peripheral neuropathy in North Central Nigeria

BackgroundPeripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) are two of the leading causes of non-traumatic amputation worldwide with tremendous negative effects on the quality of life, psychosocial well-being of persons with diabetes mellitus; and a great burden on health care expenditure. It is therefore imperative, to identify the common and contrast determinants of PAD and DPN in order to ease adoption of common and specific strategies for their early prevention.MethodsThis was a multi-center cross-sectional study which involved the consecutive enrolment of one thousand and forty (1040) participants following consent and waiver of ethical approval. Relevant medical history, anthropometric measurements, other clinical examinations including measurement of ankle-brachial index (ABI) and neurological examinations were undertaken. IBM SPSS version 23 was used for statistical analysis and logistic regression was used to assess for the common and contrast determinants of PAD and DPN. Significance level used was p < 0.05.ResultsMultiple stepwise logistic regression showed that common predictors of PAD vs DPN respectively include age, odds ratio (OR) 1.51 vs 1.99, 95 % confidence interval (CI) 1.18–2.34 vs 1.35–2.54, p = 0.033 vs 0.003; duration of DM (OR 1.51 vs 2.01, CI 1.23–1.85 vs 1.00–3.02, p = <.001 vs 0.032); central obesity (OR 9.77 vs 1.12, CI 5.07–18.82 vs 1.08–3.25, p = <.001 vs 0.047); poor SBP control (OR 2.47 vs 1.78, CI 1.26–4.87 vs 1.18–3.31, p = .016 vs 0.001); poor DBP control (OR 2.45 vs 1.45, CI 1.24–4.84 vs 1.13–2.59, p = .010 vs 0.006); poor 2HrPP control (OR 3.43 vs 2.83, CI 1.79–6.56 vs 1.31–4.17, p = <.001 vs 0.001); poor HbA1c control (OR 2.59 vs 2.31, CI 1.50–5.71 vs 1.47–3.69, p = <.001 vs 0.004).Common negative predictors or probable protective factors of PAD and DPN respectively include statins (OR 3.01 vs 2.21, CI 1.99–9.19 vs 1.45–3.26, p = .023 vs 0.004); and antiplatelets (OR 7.14 vs 2.46, CI 3.03–15.61 vs 1.09–5.53, p = .008 vs 0.030). However, only DPN was significantly predicted by female gender (OR 1.94, CI 1.39–2.25, p = 0.023), height (OR 2.02, CI 1.85–2.20, p = 0.001), generalized obesity (OR 2.02, CI 1.58–2.79, p = 0.002), and poor FPG control (OR 2.43, CI 1.50–4.10, p = 0.004)ConclusionCommon determinants of PAD and DPN included age, duration of DM, central obesity, and poor control of SBP, DBP, and 2HrPP control. Additionally, the use of antiplatelets and statins use were common inverse determinants of PAD and DPN which means they may help protect against PAD and DPN. However, only DPN was significantly predicted by female gender, height, generalized obesity, and poor control of FPG.     

中老年2型糖尿病周围神经病变患者骨代谢指标变化研究

目的探讨中老年2型糖尿病合并周围神经病变与骨代谢指标β-CTX、PINP之间的相关性。方法选取遵义医科大学附属医院内分泌科2017年10月至2018年8月的2型糖尿病患者189例,基于患者有无合并周围神经病变进行分组,将患者划分为合并病变组(DPN组)和未合并病变组(NDPN组),两组分别为97例和92例。测定各组FPG、HbA1c、C肽、FIns、HOMA-IR、TG、TC、LDL-C、HDL-C、Ca、P、BMD(L2-L4、Neck、Troch、Ward’s三角)、β-CTX、PINP水平。结果与NDPN组比较,DPN组FPG、HbA1c、FIns、HOMA-IR、TG均高于NDPN组,而P、HDL-C、腰椎L2-L4、股骨颈Neck、Troch处BMD、β-CTX、PINP低于NDPN组(P<0.05);Pearson相关性分析显示,β-CTX与FPG呈负相关(r=0.484,P<0.05);PINP与HDLC、P呈正相关(r分别为0.242、0.309,P<0.05),与HbA1c、HOMA-IR、股骨颈Neck呈负相关(r分别为-0.173、-1.460、-0.237,P<0.05)。结论DPN患者血清β-CTX、PINP水平降低,骨转换指标异常,可能具有更高的骨折风险。     

甲钴胺联合血栓通治疗糖尿病周围神经病变的安全性和有效性分析

目的结合目前所有的相关研究,对甲钴胺联合血栓通治疗糖尿病周围神经病变的安全性和有效性进行系统评价。方法本研究检索了Medline、Embase、临床对照试验中心注册数据库、万方、CNKI、VIP和中国生物医学文献数据库,检索年限到2011年9月截止。纳入的文献包括血塞通和甲钴胺联合用药与甲钴胺单独用药比较的随机对照验。两位研究者独立筛选文献,对纳入的文献进行质量评估和异质性检验,并进行亚组分析。结果最终符合纳入标准的文献共7篇。Meta分析结果显示,用血栓通治疗糖尿病周围神经病变（DPN）患者腱反射及自觉症状有显著改善（RR 1.90;95%CI 1.65-2.18）。亚组meta分析也显示,血栓通能缓解临床症状,即短疗程（RR 2.15;95%CI 1.77-2.62）和长疗程（RR 1.48;95%CI 1.23-1.78）;小剂量血栓通（RR 1.86;95%CI 1.44-2.39）和大剂量血栓通（RR 1.62;95%CI 1.15-2.28）;神经传导速度指标（RR 1.86;95%CI 1.52-2.27）和无神经传导速度（RR 1.90;95%CI 1.29-2.78）。不良反应方面,由于数据不完整,难以进行定量分析。结论血栓通作为辅助疗法对治疗糖尿病周围神经病变可能有效,但由于纳入的研究存在方法学质量方面的缺陷及样本量太小,并不能明确的得出血栓通对糖尿病周围神经病变有效的结论。我们需要更多高质量、大规模的临床随机对照试验来进一步证实血栓通的安全性和有效性。     

中药泡足联合药棒按摩及换药用于糖尿病周围神经病变

目的探讨对糖尿病周围神经病变(DPN)患者实施综合性中医药护理干预的疗效。方法将120例DPN患者随机分为观察组和对照组各60例,两组均行中西医结合治疗,在此基础上对照组给予常规护理,观察组增加针对病期的中药泡足联合药棒按摩及换药干预。2个疗程后评价效果。结果观察组DPN疗效显著优于对照组(P<0.01)。结论对DPN在中西医结合治疗的基础上,行针对病期的中药泡足联合药棒按摩及换药可提高疗效。     

2型糖尿病患者周围神经病变预测模型的构建

目的 比较不同检测方法基于局部热充血的2型糖尿病周围神经病变预测模型性能，为临床早期筛查提供参考。方法纳入174例2型糖尿病患者，在试验局部加热至44℃并使用激光多普勒血流仪测量血流变化率。同时进行临床5项筛查、震动感觉阈值测定和神经传导检查，根据各自的诊断标准，采用多因素logistic回归分析探讨糖尿病周围神经病变的影响因素。以神经传导检查为“金标准”，筛选最优模型构建 列线图预测模型。结果3种检测方法均提示，血流变化率、糖尿病病程、糖尿病肾病、糖化血红蛋白是糖尿病周围神经病变的影响因素（均P<0.05）。根据临床5项筛查结果建立的logit模型性能最好，据此构建的列线图模型具有较好的准确度（Hosmer Lemeshow检验χ2=11.147，P＞0.05）和区分度（AUC=0.872）。 结论血流变化率、糖尿病病程、糖尿病肾病和糖化血红蛋白是糖尿病周围神经病变的影响因素。以临床5项筛查结果构建的列线图模型具有良好的诊断效能，可为临床筛选、识别糖尿病周围神经病变患者提供参考。